tbuckley/cabot-search huggingface dataset:
Abstract P364: Healthcare Utilization Among Asian, African, and Latino Immigrants With Hypertension or Diabetes in the 2010-2018 National Health Interview Survey
Authors: Chinenye C Azoba, Ruth-Alma N Turkson-Ocran, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Background: Cardiovascular disease (CVD) morbidity and mortality disproportionately affect racial and ethnic minority groups and can be mitigated by preventative services. However, research describing healthcare use in immigrants with CVD risk in the US is limited. Hypothesis: Immigrants with hypertension or diabetes will have lower healthcare utilization (HCU) than US-born non-Hispanic (NH) White adults. Methods: We analyzed cross-sectional data from the 2010-2018 National Health Interview Survey on 75,631 adults including Asian (N=3,120), African (N=393), and Latino (N=7,315) immigrants and US-born NH White adults (N=64,803) with hypertension or diabetes. HCU was defined as seen/talked to a general doctor, ≥1 doctor’s office visit, and ≥1 emergency department (ED) visit in the past 12 months. We used logistic regression to examine HCU disparities between immigrants and NH White adults and compared HCU among immigrants stratified by length of US residence. Results: Participants had a mean (±SE) age of 60.4 (±0.1) years, and 52% were female. Compared to NH White adults, Asian (adjusted odds ratio [aOR]: 0.79, 95% CI: 0.69-0.89, Table ), African (aOR: 0.68, 95% CI: 0.50-0.93), and Latino (aOR: 0.68, 95% CI: 0.62-0.74) immigrants were less likely to have seen/talked to a doctor in the past 12 months. All immigrant groups were also less likely to have ≥1 doctor office visit. Asian (aOR: 0.61, 95% CI: 0.55-0.68) and Latino (aOR: 0.85, 95% CI: 0.79-0.91) immigrants were less likely to have ≥1 ED visit than NH White adults. Compared to those with &lt;10 years of US residence, HCU improved in immigrants with ≥10 years of residence (data not shown). Conclusion: Immigrants with CVD risk use less health services than NH White adults, yet HCU improves with longer US residence. CVD health policies must account for heterogeneity among immigrant groups, with targeted efforts toward recent immigrants, to improve HCU and prevent CVD complications.
Abstract MP45: Nocturnal Hypoxemia, Obstructive Sleep Apnea and the Risk of Cardiovascular Diseases and Mortality: Insights From the Atherosclerosis Risk in Communities Participants of the Sleep Heart Health Study
Authors: Jeffrey R Misialek, Kelsie M Full, Brittanny M Polanka, Kamakshi Lakshminarayan, Rebecca F Gottesman, Jayandra J Himali, Matthew P Pase, Pamela L Lutsey
Journal: Circulation (2023)

Background: Nocturnal hypoxemia may better capture disease burden than obstructive sleep apnea (OSA). Using a subset of participants from the Atherosclerosis Risk in Communities (ARIC) study who participated in the Sleep Heart Health Study (SHHS), we examined the association of nocturnal hypoxemia and OSA with cardiovascular diseases (CVD) and mortality in a white, older cohort in the US. Methods: A total of 1,455 participants free of CVD had an in-home, overnight polysomnogram; nocturnal hypoxemia (% of total sleep time with oxygen saturation &lt;90%) and OSA (apnea-hypopnea index - # of apneas/hypopneas per hour of sleep) were derived from these readings. Incident CVD events and mortality were identified through the end of 2019 using annual telephone calls, hospital discharge lists and death certificates and were adjudicated by physician review. Included in this analysis were coronary heart disease (CHD), heart failure (HF), stroke, any CVD event (CHD, HF, or stroke), atrial fibrillation (AF), and all-cause mortality. We used Cox proportional hazards models to assess the association of nocturnal hypoxemia (categories: &lt;1%, 1-&lt;5%, ≥5%) and OSA (categories: &lt;5, 5-&lt;15, 15-&lt;30, ≥30) with each outcome. Results: At the sleep assessment, participants had a mean (SD) age of 62 (6) years, 53% were female, and 14% had a nocturnal hypoxemia ≥5%. Over a mean follow-up of 17.8 years, a total of 408 participants had any CVD event, and 602 died. Nocturnal hypoxemia ≥5% was associated with incident HF and all-cause mortality in the fully adjusted model (Table). Nocturnal hypoxemia ≥5% was also associated with incident CVD and AF in Model 1; however, adjustment for body mass index attenuated these associations (Table, Model 2). OSA was not associated with the outcomes in any model (data not shown). Conclusion: Further research is needed to understand the distinction between nocturnal hypoxemia and OSA and how they relate to the risk of CVD and mortality. It is possible that reducing nocturnal hypoxemia should be targeted over OSA for CVD prevention.
Abstract P433: Predictors of Self-Reported Medication Non-Adherence in Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Christina Yin, B Gwen Windham, Anna Kucharska-Newton, David Couper, Pamela L Lutsey, Shoshana Ballew, Jung-Im Shin
Journal: Circulation (2023)

Introduction: Medication non-adherence increases the risk of hospitalization and mortality in older adults. Evidence from previous studies was not conclusive due to small sample size or lack of adjustment for potential confounders. This study aims to investigate the prevalence and predictors of medication non-adherence in older adults, considering both individual-level and neighborhood-level factors. Methods: We studied participants (aged 66-90 years) who were on at least one medication at visit 5 (2011-2013) of the ARIC Study. Potential predictors included demographic factors, individual-level and neighborhood-level socioeconomic factors, behavioral factors, depressive symptoms, and cognitive function. We estimated the prevalence of self-reported medication adherence using the Morisky Green Levine medication adherence questionnaire and considered intermediate and low as medication non-adherence. We used multivariable logistic regression to identify independent predictors of medication non-adherence, further adjusting for race-center, insurance types, comorbidities, and number of medications. Results: Among 5304 participants (mean age of 75.5 [SD 5.1] years, 21.6% Black, and 58.2% female), 2.3% and 37.1% reported low and intermediate medication adherence, respectively. After adjustment, age 66-74 (odds ratio [OR]= 1.23 [95% CI, 1.10-1.38]), current drinker (1.31 [1.10-1.55]), lack of physical activity (PA) (1.18 [1.01-1.37] for intermediate PA; 1.38 [1.21-1.58] for low PA), and depressive symptoms (2.30 [1.82-2.91]) were significant predictors of medication non-adherence ( Table ). Education and ADI were not associated with medication non-adherence. Conclusions: We found that almost 40% of older adults have medication non-adherence. Unhealthy lifestyle factors and depressive symptoms were associated with medication non-adherence. Education and neighborhood-level SES were not. Depression is an important modifiable factor to improve medication adherence in older adults.
Abstract P192: Assessment of Medical Trainee Identification of Cardiovascular Disease Risk Factors in the LGBTQ Community: A Quality Improvement Initiative
Authors: Kisha L Burgess, Adeyinka Adeniyi, Christabel Nyange, Akshay Chandora, Hee Lee, Yuna Seo, Christine Charaf, Eric Y Chang
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. However, the lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) population experiences significant disparities in CVD risk factors, placing them at higher risk for developing CVD. Assessing and addressing risk factors (RF) in this population requires identifying and addressing modifiable barriers in a timely fashion. We aimed to evaluate trainee assessment of CVD RF in the LGBTQ community while identifying potential barriers as opportunities for intervention. Methods: This was a multi-institutional study performed at three academic training programs in Georgia. An anonymous questionnaire was used to assess trainees' (interns, residents, and medical students) identification and perception of CVD RF in the LGBTQ community. The data was compiled and analyzed to identify perceived barriers to LGBTQ CVD RF assessment by medical trainees. Results: A total of 168 surveys were returned. More than a third (37%; 62/168) of trainees noted that the LGBTQ community is at increased risk of developing CVD compared to their cisgender heterosexual peers. Only 3.6% (6/168) reported complete confidence in assessing CVD risk factors in the LGBTQ community. The most identified (90%; 152/168) RF was environmental stress such as discrimination, rejection, and violence followed by HIV/AIDs (83%; 139/168) and hormone replacement therapies (81%; 136/168). Almost half (48%; 77/161) of trainees noted that they address risk factors for CVD in the LGBTQ community less than 25% of the time, listing a lack of knowledge of the unique risk factors in the LGBTQ community 45% (69/152) as the most significant barrier. Conclusion: Identifying and addressing unique CVD RF in LGBTQ populations is pivotal to improving overall CVD outcomes. Medical teaching teams and training programs can play a leading role in educating trainees about these unique risk factors and helping to address knowledge barriers. Our study demonstrates that medical trainees are largely unaware that the LGBTQ community is at increased risk for CVD, presenting a significant opportunity to address cardiovascular health disparities in this community through intentional changes in the structure of medical education.
Abstract P575: Self-Rated Health and Mortality in the Elderly: A Comparison Between Jewish and Arab Populations in Israel
Authors: Itamar Shafran, Yael Benyamini, Lital Keinan Boker, Yariv Gerber
Journal: Circulation (2023)

Introduction: Self-rated health (SRH) has been shown to predict morbidity and mortality across the lifespan. However, its predictive value might differ between populations, affected by socioeconomic and cultural factors. We investigated the association between SRH and mortality among the elderly population in Israel, comparing the Jewish and Arab ethnic groups. Methods: A prospective cohort study based on the first National Health and Nutrition Survey of Older Adults (“Mabat Zahav” 2005-2006, n=1761), consisting of Jewish (n=1463) and Arab (n=298) participants. SRH was measured on a 4-point scale. Mortality data were retrieved from the National Death Registry (through 2019). Survival analysis was performed using Cox regression models, adjusted for sociodemographic factors and comorbidity burden. Results: Mean age (SD) was 75 (±6) and 72 (±5) years in the Jewish (54% women) and Arab (50% women) groups, respectively. Jewish participants were more likely to rate their health as not good or poor than Arab participants (35% vs. 29% and 11% vs. 8%, respectively, P=0.01). During a median follow-up of 13 (IQR: 8-13) years, 896 deaths occurred, 152 in the Arab group. The age- and sex-adjusted hazard ratio (HR) for mortality in the Arab vs. Jewish participants was 1.33 (95% CI: 1.12-1.60). Mortality HRs associated with SRH by ethnicity are shown in the Table. A stepwise increase in the adjusted risk was observed with increasing SRH in both ethnic groups, with no interaction detected. Conclusions: Although Jewish participants had poorer SRH, their survival rate was higher than the Arab participants. Poor SRH was equally associated with higher mortality in both groups. Further research is warranted to understand better the factors influencing SRH gradings in Jewish vs. Arab older adults.
Abstract P662: Thyroid Peroxidase Antibodies is Associated With Carotid Intima-Media Thickness in the Brazilian Longitudinal Study of Adult Health
Authors: Vandrize Meneghini, William Tebar, Itamar S Santos, Carolina Janovsky, Paulo A Lotufo, Alessandra C Goulart, Isabela M Bensenor
Journal: Circulation (2023)

Introduction: There is an association between thyroid autoimmunity and the cardiovascular system, however, it remains unclear whether detectability and positivity of thyroid peroxidase antibodies (TPOAb) could contribute to the development of atherosclerosis. Hypothesis: We assessed the hypothesis that there is an association of multiple categories of TPOAb with increased carotid intima-media thickness (cIMT) in participants from the ELSA-Brasil study. Methods: This is a cross-sectional study using baseline data of 9651 participants (mean age of 51.5 years-old, 55.8% women), without a history of cardiovascular disease. Fasting serum TPOAb levels were determined (Roche Diagnostics) and categorized as undetectable (≤ 5.00 IU/mL), low detectable (5.01-14.99 IU/mL), high detectable (15.00-33.99 IU/mL), and positive (34.00-600.00 IU/mL). Values of cIMT above the 75th percentile (≥0.68) were classified as “increased cIMT”. We performed logistic regression models, univariate and adjusted (for sex, age, BMI, smoking, alcohol consumption, diabetes, hypertension, dyslipidemia, and family history of cardiovascular disease), to determine odds ratio (OR) and 95% confidence intervals (CI). Results: Increased cIMT was prevalent in 24.4% of our sample, without statistically significant difference among the categories of TPOAb (p=0.066). Compared to undetectable TPOAb, low detectable category was associated with higher odds of having increased cIMT in univariate (OR=1.37, CI= 1.04-1.82) and remained associated after the adjustment for all confounders (OR=1.39, CI= 1.01-1.91). TPOAb high detectability was associated with increased cIMT only in the univariate (OR=1.40, CI= 1.04-1.88) and after adjustment for sex, age and BMI (OR=1.42, CI= 1.02-1.97). No association was seen for TPOAb positivity and cIMT (OR= 1.29, CI= 0.91-1.83). Conclusions: In conclusion, the modest association of low detectable TPOAb with cIMT may suggest a possible role of TPOAb in the atherosclerotic process.
Abstract P326: Higher Mortality and Risk for Cardiogenic Shock in Patients With Diabetes Mellitus and Atrial Fibrillation Affected by Pulmonary Hypertension
Authors: Leonid Khokhlov, Amr Aboelnasr, Fatima Hussain, Mehnaaz Ali, Michael Fatuyi, Leanne Pereira, Kamal Shemisa
Journal: Circulation (2023)

Background: Population with diabetes mellitus (DM) &amp; atrial fibrillation (AF) is a growing medical problem. Although, pulmonary hypertension (PH) is a recognized entity that poses higher medical risks, there is limited scientific evidence of clinical outcomes in population with AF&amp;DM affected by PH. Therefore, we sought to investigate this population. Methods: We queried NIS between 2016-2019 for adult patients who were hospitalized with AF&amp;DM and had PH. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute respiratory failure, invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value &lt; 0.05 was significant. Results: There were 6,723,293 patients with AF&amp;DM and 802,004 (12%) had PH. PH and non-PH cohorts were with mean age of 74.6 vs. 73.6 yrs; males 46.6% vs 56.9%; Caucasians 70.9% vs 74.2%; HTN 13.4% vs 30.9%; HF 83% vs 52.6%; CKD 58.5% vs 43.7%; obese 33.4% vs 26.3%; dyslipidemia 62.2% vs 61.3%; anemia 24.4% vs 18.7%; history of MI 13.3% vs 13.2%; stroke 2.5% vs 4.2%, COPD 41.5% vs 29.6%; nicotine use 7.5% vs 9.5%, respectively. PH cohort had significantly higher mortality and worse clinical outcomes (Table 1). Conclusion: AF&amp;DM population affected by PH showed significantly worse clinical outcomes and higher resource utilization. They were older with more HF, obesity, dyslipidemia, anemia, CKD, COPD. PH is associated with cardiac dysfunction &amp; a 2-fold greater risk for cardiogenic shock. Awareness of PH among patients with AF&amp;DM is needed and additional long-term outcomes research is necessary.
Abstract P567: Cardiovascular Health Awareness and Risk Assessment in Schoolteachers in Calcutta, India
Authors: Madhab Ray, Santanu Guha, Bipasha Ray, Varun Saxena, Badri Viswanathan, Meghna Ray, Vivaan Desai, Nina Velu, Umika Paul, Ishi Singh, Srijani Ray, Dhriti Mandal, Bedatrayee Roy, Srijon Mandal, Prakash C Hazra, Chaya D Ray, Sudipta Chaudhuri, Avik Karak, Basabendra Chowdhury, Deepak L Bhatt, Robert J Goldberg, Harry P Selker
Journal: Circulation (2023)

Background: Cardiovascular disease (CVD) is the leading cause of death in India, surpassing all infectious causes. Early awareness of CVD and its risk factors and adoption of heart healthy lifestyle practices are crucial to reducing the impact of CVD in the community. Objective: To assess schoolteachers’ awareness of CVD and to compare the calculated ten-year risk of heart attack, stroke, and death by the Atherosclerotic Cardiovascular Disease (ASCVD) model to the observed event rates. Methods: We surveyed 4,150 schoolteachers out of 5,321 (78% response rate) from 400 schools in Calcutta during 2019 using a questionnaire assessing their awareness of CVD in five domains: prevalence, spectrum of CVD, its nature, risk factors, and benefits of a heart healthy lifestyle. The study population was stratified by risk tertile of their 10-year calculated ASCVD score. Results: Awareness about cardiovascular health among schoolteachers (male 41%, mean age 44 years) was low: 33 (mean score out of maximum 100), varying in different domains as shown below. Although most (86%) were at mild risk for CVD with ASCVD scores below five, nine percent had moderate risk, and five percent had high risk of CVD. There was no significant association between their risk score and their awareness of CVD health (correlation coefficient r = - 0.022, 95% confidence interval - 0.052, 0.009). Conclusions: Cardiovascular health awareness among schoolteachers in Calcutta is suboptimal, many of whom are at risk for CVD. Awareness of the disease, detection of risk factors at an early stage, and adoption of a healthy lifestyle may help reduce CVD in this community.
Abstract P459: Socioeconomic Disadvantage and Adverse Childhood Events Associated With Risk of Obesity and Insufficient Sleep in Children
Authors: Marie-Pierre St-Onge, Susan Lin, Jennifer Woo Baidal, Christina Hoven
Journal: Circulation (2023)

Introduction: Obesity and sleep problems are risk factors for various health problems. Children with both obesity and sleep problems are more likely than children with only one condition to develop cardiometabolic disorders later in life. This study estimates the prevalence of children with obesity and insufficient sleep duration and examines related demographic and social economic factors for their co-occurrence among children in the United States. Methods: Data were from the 2019 and 2020 National Survey of Children’s Health (NSCH). The NSCH provides national and state-level data on the physical and emotional health of non-institutionalized American children 0-17 y of age. For this study, children 10-17 y without missing data in the study variables (N=35678) were included. Age-adjusted, sex-specific body mass index was classified as underweight (&lt;5th percentile); normal weight (5th to &lt;85th percentile); overweight (85th to &lt;95th percentile); or obese (≥95th percentile). Age-appropriate sleep duration was defined according to American Academy of Sleep Medicine guidelines (nighttime sleep for ages 10-12 y=9-12 h; 13-17 y=8-10 h). Children who slept below the minimum recommended duration on an average weeknight in the past week were classified as having insufficient sleep. The main outcome was co-occurrence of obesity and insufficient sleep. Descriptive statistics, chi-square tests and logistic regression were used applying sampling weights to account for non-response and sampling procedures. Results: In NSCH, 16.3% of children had obesity and 34.7 % reported insufficient sleep with 7.4% of children having both conditions. Younger children (age 10-12 y) had higher prevalence of obesity with insufficient sleep (11.3%) compared to older children (age 13-17 y; 5%). Non-Hispanic Black and Hispanic children had higher prevalence of co-occurring obesity and insufficient sleep compared to non-Hispanic white children (11.4% and 11% vs 4.7%, respectively). Children in low-income households had higher prevalence (12.4%) of both obesity and insufficient sleep than higher-income counterparts (2.9%) as did children with parents reporting less than high school education compared to those with more highly educated parents (13.8 vs 5.3%). Children exposed to ≥2 adverse childhood experiences had higher prevalence than those without (10.3 vs 5%). Logistic regression analyses show all these factors were significantly associated with co-occurring obesity and insufficient sleep (p-values &lt;0.001). Conclusion: Combined prevalence of obesity and insufficient sleep duration among children varied by age, race, poverty, exposure to childhood adversity, and parental education. The study findings call attention from policy makers, pediatricians, and researchers to these co-existing health problems in children and develop effective strategies to combat obesity and improve sleep health.
Abstract P579: Predictors of Cardiogenic Shock Among Patients With Alcohol Abuse Undergoing SAVR in the United States
Authors: Balkiranjit Kaur Dhillon, Shaheen Sombans, Kamleshun Ramphul, Renuka Verma, Osama A Rehman, Sailaja Sanikommu, Yogeshwaree Ramphul, Fnu Arti, Stephanie G Mejias, Petras Lohana, Nomesh Kumar
Journal: Circulation (2023)

Introduction: While alcohol is a modifiable cause of cardiac complications, its use is on the rise. We sought to understand the predictors of cardiogenic shock (CS) among patients with a history of alcohol abuse undergoing surgical aortic valve replacement (SAVR). Hypothesis: We assessed the hypothesis that patients with alcohol abuse undergoing SAVR have various predictors of CS during hospitalization. Method: We retrospectively analyzed cases of SAVR among those with a diagnosis of alcohol abuse from the 2019 National Inpatient Sample. Logistic models helped find the adjusted odds ratio (aOR) of CS. Results: In total, 1980 patients with alcohol abuse underwent SAVR, and 10.9% (215 cases) reported an episode of CS. Blacks (aOR 2.553, CI 1.354-4.814, p=0.004) and races other than White, Black, or Hispanic (aOR 3.136, CI 1.29-7.62, p=0.012) showed higher odds of CS compared to Whites. While Medicare covered the highest proportion of CS patients (39.5%), Medicaid beneficiaries were least likely to develop CS (aOR 0.241, CI 0.132 -0.442, p&lt;0.01) compared to those on Medicare. Our study also found that patients with anemia (aOR 10.317, CI 5.234-20.334, p&lt;0.01), acute kidney injury (aOR 3.921, CI 2.54-6.052, p&lt;0.01), and cirrhosis (aOR 4.587, CI 2.719-7.736, p&lt;0.01), had higher odds of reporting CS. However, those with underlying obesity (aOR 0.237, CI 0.126-0.447, p&lt;0.01), diabetes mellitus (aOR 0.344, CI 0.197-0.602, p&lt;0.01), and hypertension (aOR 0.436, CI 0.264-0.721, p&lt;0.01) were less likely to do so. Unfortunately, 25 patients with CS (11.6%) did not survive their hospitalization (aOR 13.771, 95% CI 5.526-34.317, p&lt;0.01). Conclusion: In our analysis, we found that anemia, acute kidney injury, cirrhosis, Black race, and Races other than Black, White or Hispanic are possibly linked to a higher incidence of CS, while obesity, diabetes mellitus, hypertension, and being a Medicaid beneficiary are associated with a lower incidence of CS. Further studies and changes in protocols may help identify them early and improve outcomes.